At Visante, we talk at length about how A+O=D2 TM. In this article, we will focus on every day practices that create Access and Opportunity for drug diversion to happen within the “four walls” of the pharmacy. The things we see and do every day blind us to bad practices that leave the door open for drug diversion we are trying to prevent.
First, let’s talk about “key security.” Where do you keep “the keys?” We are never surprised by the answer we get when posing this question… as the person being questioned reaches behind them to pull “the keys” off a hook on the wall, or from an unlocked drawer beside “the cabinet.” This is an example of the Culture of Trust and how we can’t believe one of our own would steal drugs. This type of access creates opportunity where there is no accountability or definitive way to identify who the diverter may have been.
Second, let’s talk about “camera security.” You may say, “If someone were to steal drugs, they would be on camera.” That’s when we identify that there is no camera or only one camera in the entire pharmacy… and it is pointed at the door to the pharmacy, not the controlled substance cabinet. In this day and age, we thought automated controlled substances cabinets were the norm… wrong! We are surprised to find out all too frequently there are automated dispensing cabinets on the patient care units, but the drugs in the pharmacy are still in a locked cabinet. So, there’s no way to track access through automated means and often there is no camera either. For those who do have cameras in the pharmacy, how many and where? Have you actually viewed them to make sure they capture the angles and activity to detect a diversion event? Often, the answer we get is “I don’t know.” This is one area we can almost universally say that most pharmacies are under resourced.
Third, let’s talk about “receiving and restocking security.” Do you have separation of duties? (Not the same person ordering and receiving.) This is still one of the most problematic areas we see in smaller hospitals. The feeling is that “we are a family” and “know each other very well” so there isn’t anything to be concerned about… wrong! Again, the Culture of Trust rears its ugly head. Another common finding is when the pharmacy stages their controlled substance restocking in the central hub of activity in the pharmacy thinking no one will steal when the drugs are in the middle of everything and everyone is watching. In actuality, in the middle of everything and everybody, no one is really watching. When something is everyone’s responsibility, no one is accountable. Take the time to segregate duties and create accountability within your processes and practices.
“Drug Diversion: In Plain Sight” is a major source of organizational risk often overlooked by internal assessments. Having an external set of eyes review your policies and practices will help mitigate risk points not “seen” because they are In Plain Sight.